Side effects of mandibular advancement devices for sleep apnea treatment.

Our purpose was to investigate side effects of sleep apnea treatment by removable oral appliances (OA) that advance the mandible. In 22 patients suffering from obstructive sleep apnea (OSA), questionnaire evaluations, polysomnographies, cephalographies, and dental plaster casts were obtained before initiation of treatment with OA that fully covered both dental arches. Patients were reevaluated after 3 to 12 mo (questionnaires, polysomnographies) and 12 to 30 mo (questionnaires, cephalographies, plaster casts) during continuous treatment. Polysomnographies confirmed improved breathing by OA. All patients experienced persistent alleviation of symptoms after 12 to 30 mo and wished to continue treatment. Side effects were common but only mildly disturbing: mucosal dryness (86% of patients), tooth discomfort (59%), and hypersalivation (55%). Cephalographies revealed a decrease in the mean (+/- SE) upper incisors to maxillary plane angle from 102 +/- 2 degrees at baseline, to 101 +/- 2 degrees after 12 to 30 mo (p < 0.05). Overbite and overjet were also slightly (mean reduction < 1 mm) but significantly reduced. None of these side effects required discontinuation of treatment. OA are an effective therapy of obstructive sleep apnea. Mild side effects are common but rarely require intervention. Nevertheless, close follow-up during long-term therapy by OA is advisable in order to timely detect potentially relevant orthodontic changes.

A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment.

Our purpose was to compare the effectiveness and side effects of a novel, single-piece mandibular advancement device (OSA-Monobloc) for sleep apnea therapy with those of a two-piece appliance with lateral Herbst attachments (OSA-Herbst) as used in previous studies. An OSA-Monobloc and an OSA-Herbst with equal protrusion were fitted in 24 obstructive sleep apnea patients unable to use continuous positive airway pressure (CPAP) therapy. After an adaptation period of 156 +/- 14 d (mean +/- SE), patients used the OSA-Monobloc, the OSA-Herbst, and no appliance in random order, using each appliance for 1 wk. Symptom scores were recorded and sleep studies were done at the end of each week. Several symptom scores were significantly improved with both appliances, but to a greater degree with the OSA-Monobloc. Epworth Sleepiness Scale scores were 8.8 +/- 0.7 with the OSA-Herbst, and 8.6 +/- 0.8 with the OSA-Monobloc devices, and 13.1 +/- 0.9 without therapy (p < 0.05 versus both appliances). The apnea/hypopnea index was 8.7 +/- 1.5/h with the OSA-Herbst and 7.9 +/- 1.6/h with the OSA-Monobloc device, and 22.6 +/- 3.1/h without therapy (p < 0.05 versus both appliances). Side effects were mild and of equal prevalence with both appliances. Fifteen patients preferred the OSA-Monobloc, eight patients had no preference, and one patient preferred the OSA-Herbst device (p < 0.008 versus OSA-Monobloc). We conclude that both the OSA-Herbst and the OSA-Monobloc are effective therapeutic devices for sleep apnea. The OSA-Monobloc relieved symptoms to a greater extent than the OSA-Herbst, and was preferred by the majority of patients on the basis of its simple application.

Sigmoidoscopy. Is it a general practice procedure?

Sigmoidoscopy can readily be learnt and practised by a general practitioner interested in looking after patients with colorectal problems. Examination with a rigid sigmoidoscope has advantages over use of the flexible instrument for the frequent user. Details of the equipment needed for sigmoidoscopy as well as a method, precautions and some typical findings are described.

Sequence of the gene encoding hsp90e from Cryptosporidium parvum.

A composite 2364 nt DNA sequence with an open reading frame (ORF) encoding an endoplasmic reticulum-associated heat shock protein 90 (CpHsp90e) was determined from clones isolated from genomic libraries constructed from the KSU-1 isolate of Cryptosporidium parvum. Transcription was verified by isolation of a clone from a cDNA library with a similar restriction map to that observed with genomic DNA. The predicted protein consists of 787 amino acids, has a predicted molecular size of 89.2 kDa, and was found to share strong homology with other endoplasmic reticulum-associated hsp90 proteins.

Current concepts in the investigation and management of benign biliary disease.

The various manifestations and complications of biliary disease lead to its diverse presentations. The choice and urgency of investigation are a clinical challenge. The treatment of symptomatic and asymptomatic disease remain controversial, despite increasing simplicity and safety of surgery especially for uncomplicated disease.

Low dose, short duration therapy for the eradication of Helicobacter pylori in patients with duodenal ulcer.

OBJECTIVE: To study the efficacy and acceptability of low dose, short duration triple therapy in eradicating Helicobacter pylori from patients with duodenal ulcer. DESIGN: A prospective study of 105 patients with H. pylori associated duodenal ulcer presenting consecutively to a regional Melbourne general hospital and a local private endoscopy clinic. INTERVENTIONS: Patients were treated with H2-antagonists (if required), followed by two weeks of triple therapy consisting of colloidal bismuth subcitrate (Denol) one tablet four times daily between meals, tetracycline hydrochloride 250 mg four times daily and metronidazole 400 mg twice daily. Four weeks, and again 12 months after treatment, patients were assessed by gastroscopy and antral biopsy for ulceration and H. pylori as measured by rapid urease test. Side effects of treatment were documented. RESULTS: Four patients withdrew because of drug side effects. Of 101 patients completing treatment, H. pylori was eradicated in 91 (90%, or 87% of total). Eight of the 10 patients in whom initial treatment failed received one or more further courses of triple therapy, with H. pylori being eradicated in five. Mild nausea occurred in 6% and possible candida infection in 3%. Of 68 patients who were reassessed after 12 months, 66 were still clear of H. pylori but, in four, small superficial ulcers were present. Two patients were positive for H. pylori, one with and one without ulceration, giving an H. pylori recurrence rate of 3% and an ulcer recurrence rate of 7%. CONCLUSIONS: This particular regimen of triple therapy was highly effective, safe and acceptable and could be offered to all patients with H. pylori associated duodenal ulcer.

Office treatment of haemorrhoids and perianal haematoma.

Most patients with haemorrhoids can be treated successfully with office procedures. Careful assessment of patients bleeding from the rectum should help identify more sinister conditions. Clinical assessment should allow patients to be selected for different treatments, ensuring good long-term results. Placebo treatments are best avoided. Follow up is desirable to exclude or treat any underlying condition.

The management of ingrown toenails.

Ingrown toenail is an unpleasant condition often affecting young people. Surgery is often necessary for its treatment. A simple office procedure is described, with details and special precautions, which results in few complications and generally a good outcome.

Management of breast cysts: practical procedures.

Many women are subjected to unnecessary mutilation of their breasts in an over zealous endeavour to remove lumps. On the other hand it is vitally important to regard all breast lumps with suspicion and detect and remove the malignant lump as soon as possible. Breast cysts can be confusing to manage but Mr. Iseli has outlined a very logical management plan with guidelines for recognition of the malignant lesion.

Retained gallstones: the choice of the method of management.

The management of 26 patients with retained stones in the biliary tree after surgery is described. Various methods have been used, but intermittent rapid flushing with one litre of isotonic saline solution, together with a slow infusion of heparin solution via the T tube, was the most successful. It required no specialized equipment, and is recommended as the first choice in treatment.

Choledochoscopy: a comparison of a rigid and a flexible fibreoptic instrument.

A comparison of choledochoscopy using a Storz rigid choledochoscope and a flexible Olympus instrument has been made. After using both instruments during a 12-month period, it is felt that the rigid instrument has practical advantages for general use, while the flexible instrument offers additional benefits, but requires more skill and care in its use.